Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

• Published in: World Journal of Surgical Oncology Vol. 19; no. 1; pp. 85 - 11
• Main Authors: Kurata, Yoshihiro, Shiraki, Takayuki, Ichinose, Masanori, Kubota, Keiichi, Imai, Yasuo
• Format: Journal Article
• Language: English
• Published: London Springer Science and Business Media LLC 22.03.2021; BioMed Central; BioMed Central Ltd; BMC
• Subjects: Adenocarcinoma; Adenocarcinoma - drug therapy; Adenocarcinoma - surgery; Adjuvant treatment; Antineoplastic Combined Chemotherapy Protocols; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Cancer therapies; Carcinoma, Pancreatic Ductal; Carcinoma, Pancreatic Ductal - drug therapy; Carcinoma, Pancreatic Ductal - surgery; Care and treatment; Chemotherapy; Development and progression; Gemcitabine; GS; Humans; Medical prognosis; Medicine; Medicine & Public Health; Metastases; Metastasis; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; Pancreas; Pancreatectomy; Pancreatic cancer; Pancreatic ductal adenocarcinoma; Pancreatic Neoplasms; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy; Patients; Prognosis; RC254-282; RD1-811; Retrospective Studies; S-1; Statistical analysis; Surgery; Surgical Oncology; Tumor cells; Tumors; Upfront surgery; Veins & arteries; Japan; Neoadjuvant chemotherapy; Prognosis; Gemcitabine; Pancreatic ductal adenocarcinoma; S-1; Micro-metastasis; Downstaging; GS; Upfront surgery
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-021-02192-8

Background Effect of neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC) has remained under investigation. We investigated its effect from a unique perspective and discussed its application. Patients and methods We retrospecively analyzed consecutive 131 PDAC patients who underwent pancreatoduodenectomy and distal pancreatectomy. Clinicopathologic data at surgery and postoperative prognosis were compared between patients who underwent upfront surgery (UFS) ( n = 64) and those who received NAC ( n = 67), of which 62 (92.5%) received gemcitabine plus S-1 (GS). The GS regimen resulted in about 15% of partial response and 85% of stable disease in a previous study which analyzed a subset of this study subjects. Results Tumor size was marginally smaller, degree of nodal metastasis and rate of distant metastasis were significantly lower, and pathologic stage was significantly lower in the NAC group than in the UFS group. In contrast, significant differences were not observed in histopathologic features such as vessel and perineural invasions and differentiation grade. Notably, disease-free and overall survivals were similar between the two groups adjusted for the pathologic stage, suggesting that effects of NAC, including macroscopically undetectable ones such as control of micro-metastasis and devitalizing tumor cells, may not be remarkable in the majority of PDAC, at least with respect to the GS regimen. Conclusions NAC may be useful in downstaging and improving prognosis in a small subset of tumors. However, postoperative prognosis may be determined at the pathologic stage of resected specimen with or without NAC. Therefore, NAC may be applicable to borderline resectable and locally advanced PDAC for enabling surgical resection, but UFS would be desirable for primary resectable PDAC.